Moexipril and hydrochlorothiazide (Uniretic) is a combination of an ACE-inhibitor and a thiazide diuretic that is used in the treatment of patients with hypertension.
Moexipril and hydrochlorothiazide (Uniretic) Uses:
-
Hypertension:
- It is used to manage hypertension.
[bg_collapse view="button-blue" color="#f7f2f2" icon="arrow" expand_text="Adult dose" collapse_text="Adult dose" ] Note: Not first-line drug, dose vary person to person, may be substituted for individual components in patients currently maintained on both agents separately or in patients not controlled with monotherapy.
Moexipril and hydrochlorothiazide (Uniretic) Dose in the treatment of Hypertension:
- Oral:
- Initial: Moexipril 7.5 mg/hydrochlorothiazide 12.5 mg or moexipril 15 mg/hydrochlorothiazide 12.5 mg OR
- moexipril 15 mg/hydrochlorothiazide 25 mg once per day in hypertensive patient with ineffective monotherapy.
- Titrate dosage based on clinical response;
- Dose range: moexipril 3.75 to 30 mg/hydrochlorothiazide 6.25 to 50 mg once daily
[/bg_collapse] [bg_collapse view="button-blue" color="#f7f2f2" icon="arrow" expand_text="Dose in Children" collapse_text="Dose in Children" ]
Uniretic use in Children:
Not indicated. [/bg_collapse] [bg_collapse view="button-blue" color="#f7f2f2" icon="arrow" expand_text="Dose in Pregnancy & lactation" collapse_text="Dose in Pregnancy & lactation" ]
Uniretic Pregnancy Risk Factor D
-
- [US Boxed Warning]Drugs that affect the renin/angiotensin systems (RAAS) may cause injury or death for the developing fetus. Use caution with females of childbearing age and immediately stop if you are pregnant.
- You can also contact individual agents.
Use of hydrochlorothiazide and moexipril during breastfeeding
- There is no data available on whether moexipril was excreted in breastmilk or not.
- Breast milk contains thiazide diuretics.
- Due to its adverse effects on nursing infants, it is best to stop drug administration and to breastfeed.
[bg_collapse view="button-blue" color="#f7f2f2" icon="arrow" expand_text="Renal Dose" collapse_text="Renal Dose" ]
Moexipril and hydrochlorothiazide (Uniretic) Dose in Kidney Disease:
-
CrCl >40 mL/minute/1.73 m²:
- No dosage adjustment is needed
-
CrCl ≤40 mL/minute/1.73 m²:
- Not recommended. Also, see individual agents.
[/bg_collapse] [bg_collapse view="button-blue" color="#f7f2f2" icon="arrow" expand_text="Dose in Liver disease" collapse_text="Dose in Liver disease" ]
Dose in Liver disease:
There are no dosage adjustments provided in the manufacturer’s labeling; Use with caution as hepatic impairment increases systemic exposure. [/bg_collapse] [bg_collapse view="button-blue" color="#f7f2f2" icon="arrow" expand_text="Side effects" collapse_text="Side effects" ]
Side effects of Moexipril and hydrochlorothiazide (Uniretic):
See individual agents (Moexipril and hydrochlorothiazide). [/bg_collapse] [bg_collapse view="button-blue" color="#f7f2f2" icon="arrow" expand_text="Contraindications & warnings" collapse_text="Contraindications & warnings" ]
Contraindications to Moexipril and hydrochlorothiazide (Uniretic):
-
-
- Hypersensitivity to any drug component,
- Angioedema due to an ACE inhibitor treatment in the past
- concomitant use with aliskiren in patients with diabetes mellitus;
- anuria
-
It is difficult to document allergenic cross-reactivity with ACE inhibitors. Cross-sensitivity is possible due to similarities in chemical structure or pharmacologic effects. Notification: Although the FDA approved product labeling states this medication is contraindicated with other sulfonamide-containing drug classes, the scientific basis of this statement has been challenged.
Warnings and precautions
-
-
Angioedema
- Angioedema can be caused by the use of ACE inhibitors, most often at low doses. Edema usually affects the head, neck and intestines. This can cause severe breathing problems or abdominal pain.
- The most vulnerable population are African-Americans, hereditary angioedema and African-Americans.
- Angioedema can also be increased by the use of everolimus (eg, mTOR inhibitor) therapy.
- You may need to be monitored frequently if you have a tongue, glottis or larynx. They can cause serious complications such as airway obstruction.
- Patients who have had airway surgery are more at risk for obstruction.
- It is crucial to be aggressive early and appropriately managed.
- Contraindicated if there are any previous cases of angioedema related to ACE inhibitor therapy
-
Cholestatic jaundice
- Cholestatic jaundice is a rare side effect of ACE inhibitors. It can progress to fulminant hepatic neoplasm (some fatal); stop taking ACE inhibitors if you notice a marked increase in hepatic transaminases and jaundice.
-
Cough:
- It can cause a dry, nonproductive cough that may occur during the first months of therapy. This may go away after discontinuing therapy.
- Before discontinuing treatment, it is important to consider other causes of cough (eg, pulmonary congestion in heart failure patients).
-
Electrolyte disturbances:
- Hyperkalemia can occur when ACE inhibitors are used. Risk factors include kidney dysfunction, diabetes mellitus and concomitant potassium-sparing diuretics and potassium supplements.
- These agents should be used with caution and potassium should be monitored closely.
- Hypokalemia, hypochloremic acidosis, hypomagnesemia and hyponatremia can be caused by Thiazide diuretics.
-
Gout
- Hydrochlorothiazide can trigger gout in certain patients who have a history of gout or are at risk for chronic renal failure.
- Doses of 25 mg and more may increase the risk.
-
Hypersensitivity reactions
- Anaphylactic/anaphylactoid reactions can occur with ACE inhibitors.
- Anaphylactoid reactions can be severe during hemodialysis (eg CVVHD) and high-flux dialysis membranes, (eg AN69), or, rarely, during low density lipoprotein (low-density) apheresis using dextran sulfatecellulose.
- Patients who have received ACE inhibitors and are subject to sensitization with Hymenoptera (bee or wasp) venom have had rare cases of anaphylactic reactions.
- Hydrochlorothiazide can also cause hypersensitivity reactions. Patients with allergies or bronchial asthma are at greater risk.
-
Hypotension/ Syncope
- ACE inhibitors can cause hypotension, with or without syncope (usually after the first few doses). Patients with low volume are more likely to experience hypotension. It is important to ensure that the patient has sufficient volume before initiating treatment. Particularly with dosing increases and initial dosing, close monitoring is necessary. Blood pressure should be decreased at a pace that is appropriate for the patient's clinical conditions.
- Hypotension, even though it may be necessary to reduce doses, is not a reason to stop future ACE inhibitor usage. This is especially true for patients with heart disease where a decrease in systolic pressure is desirable.
-
Neutropenia/agranulocytosis:
- Captopril, another ACE inhibitor has been linked to rare cases of agranulocytosis or neutropenia.
- Patients with severe renal impairment are at higher risk of developing neutropenia.
- Patients who have both collagen vascular disease and renal impairment (eg systemic lupus-erythematosus), are more at risk for developing neutropenia.
- Monitor CBC regularly with a differential in such patients.
-
Ocular effects
- Patients with acute visual acuity and ocular pain may experience hydrochlorothiazide-induced transient myopia or acute angle-closure vision loss.
- If intraocular pressure is not controlled, additional treatments may be required.
- Penicillin-allergic and sulfonamide users are at higher risk.
-
Photosensitivity
- Patients may develop photosensitivity.
-
Renal function deterioration:
- Moexipril can cause a decline in renal function, as well as an increase in serum creatinine and BUN, especially in patients with low renal bloodflow (eg, kidney artery stenosis or heart failure), whose glomerular filter rate (GFR), is dependent on efferent arterial vasoconstriction (angiotensin 2); this may lead to oliguria and acute renal failure.
- Patients with significant and progressive deterioration of renal function may experience small increases in serum creatinine after initiation.
-
Allergy to sulfonamide ("sulfa")
- FDA-approved product labels for medications that contain a sulfonamide chemical groups include a wide contraindication for patients who have had an allergic reaction to sulfonamides in the past.
- Cross-reactivity is possible between members of one class (eg two antibiotic sulfonamides).
- Crossreactivity concerns have been raised previously for all compounds with the sulfonamide structural (SO-NH).
- A deeper understanding of allergic mechanisms suggests that cross-reactivity between nonantibiotic and antibiotic sulfonamides is unlikely.
- Nonantibiotic sulfonamides are not likely to cause anaphylaxis (anaphylaxis), or mechanisms of cross-reaction due antibody production.
- T-cell-mediated (type IV), reactions (e.g. maculopapular skin rash) are less understood. It is difficult to exclude this possibility based on current knowledge.
- Some clinicians opt to avoid these classes in cases of severe reactions (Stevens Johnson syndrome/TEN).
-
Aortic stenosis
- Patients with aortic Stenosis should be cautious when using moexipril. It may cause coronary perfusion problems which could lead to ischemia.
-
Bariatric surgery
- Dehydration: Do not take diuretics within the first 24 hours after bariatric surgery. Electrolyte imbalances and severe dehydration could occur.
- Once the patient has enough water, diuretics can be resumed.
-
Cardiovascular disease
- Patients with ischemic heart disease and cerebrovascular diseases should be closely monitored when initiating therapy. This is because of the possible consequences of falling blood pressure (eg stroke, MI).
- If necessary, fluid replacement may be required to restore blood pressure. Therapy may then resume.
- Patients with hypotension recur should be stopped from receiving therapy.
-
Collagen vascular disease:
- Patients with collagen vascular disease, especially concomitant renal impairment, should be cautious when using ACE inhibitors. They may be at greater risk of developing hematologic toxicities.
- Hydrochlorothiazide can trigger or exacerbate systemic lupus, which may lead to SLE.
-
Diabetes:
- Patients with diabetes should be cautious when using Hydrochlorothiazide. You may experience a decrease in glucose control.
-
Hepatic impairment
- Patients with hepatic impairment should be cautious
- Avoid electrolyte imbalances and acid/base imbalances in progressive or severe liver disease. This could lead to hepatic emboli/coma.
-
Hypercalcemia:
- The excretion of calcium from the kidneys may be decreased by thiazide diuretics. If hypercalcemia is present, do not take thiazides.
-
Hypercholesterolemia:
- Patients with high or moderate cholesterol levels should be cautious. Thiazides can increase cholesterol and triglyceride levels.
-
Hypertrophic cardiomyopathy with outflow tract obstruction (HCM)
- Patients with HCM or outflow tract obstruction should be cautious when using moexipril. A reduction in afterload could worsen the symptoms.
-
Parathyroid disease
- Thiazide diuretics decrease calcium excretion. With prolonged use, pathologic changes in the parathyroid glands may result in hypercalcemia and hypophosphatemia. Before starting therapy, it is important to assess the parathyroid function and keep an eye on it.
-
Renal artery stenosis
- Moexipril is safe to use in patients with unstented unilateral/bilateral stenosis of the renal arteries, but there are precautions.
- If unstented bilateral renal arterial stenosis exists, it is best to avoid use unless the potential benefits outweigh the risks.
-
Renal impairment
- Preexisting renal impairments should be treated with caution. Dosage adjustments may be necessary.
- Do not increase your dose too quickly as this could cause further renal impairment.
- Patients with impaired renal function may experience cumulative effects, including azotemia.
- Hydrochlorothiazide should not be used in severe renal impairment.
- Contraindicated for anuric patients
-
Moexipril and hydrochlorothiazide: Drug Interaction
|
Ajmaline |
Sulfonamides may enhance the adverse/toxic effect of Ajmaline. Specifically, the risk for cholestasis may be increased. |
|
Alcohol (Ethyl) |
May enhance the orthostatic hypotensive effect of Thiazide and Thiazide-Like Diuretics. |
|
Alfuzosin |
May enhance the hypotensive effect of Blood Pressure Lowering Agents. |
|
Alteplase |
Angiotensin-Converting Enzyme Inhibitors may enhance the adverse/toxic effect of Alteplase. Specifically, the risk for angioedema may be increased. |
|
Aminolevulinic Acid (Topical) |
Photosensitizing Agents may enhance the photosensitizing effect of Aminolevulinic Acid (Topical). |
|
Amphetamines |
May diminish the antihypertensive effect of Antihypertensive Agents. |
|
Angiotensin II |
Angiotensin-Converting Enzyme Inhibitors may enhance the therapeutic effect of Angiotensin II. |
|
Angiotensin-Converting Enzyme Inhibitors |
Thiazide and Thiazide-Like Diuretics may enhance the hypotensive effect of Angiotensin-Converting Enzyme Inhibitors. Thiazide and Thiazide-Like Diuretics may enhance the nephrotoxic effect of Angiotensin-Converting Enzyme Inhibitors. |
|
Anticholinergic Agents |
May increase the serum concentration of Thiazide and Thiazide-Like Diuretics. |
|
Antidiabetic Agents |
Thiazide and Thiazide-Like Diuretics may diminish the therapeutic effect of Antidiabetic Agents. |
|
Antidiabetic Agents |
Hyperglycemia-Associated Agents may diminish the therapeutic effect of Antidiabetic Agents. |
|
Antipsychotic Agents (Second Generation [Atypical]) |
Blood Pressure Lowering Agents may enhance the hypotensive effect of Antipsychotic Agents (Second Generation [Atypical]). |
|
Aprotinin |
May diminish the antihypertensive effect of Angiotensin-Converting Enzyme Inhibitors. |
|
AzaTHIOprine |
Angiotensin-Converting Enzyme Inhibitors may enhance the myelosuppressive effect of AzaTHIOprine. |
|
Barbiturates |
May enhance the hypotensive effect of Blood Pressure Lowering Agents. |
|
Benazepril |
HydroCHLOROthiazide may enhance the hypotensive effect of Benazepril. HydroCHLOROthiazide may enhance the nephrotoxic effect of Benazepril. Benazepril may decrease the serum concentration of HydroCHLOROthiazide. |
|
Benperidol |
May enhance the hypotensive effect of Blood Pressure Lowering Agents. |
|
Beta2-Agonists |
May enhance the hypokalemic effect of Thiazide and Thiazide-Like Diuretics. |
|
Brigatinib |
May diminish the antihypertensive effect of Antihypertensive Agents. Brigatinib may enhance the bradycardic effect of Antihypertensive Agents. |
|
Brimonidine (Topical) |
May enhance the hypotensive effect of Blood Pressure Lowering Agents. |
|
Calcium Salts |
Thiazide and Thiazide-Like Diuretics may decrease the excretion of Calcium Salts. Continued concomitant use can also result in metabolic alkalosis. |
|
CarBAMazepine |
Thiazide and Thiazide-Like Diuretics may enhance the adverse/toxic effect of CarBAMazepine. Specifically, there may be an increased risk for hyponatremia. |
|
Cardiac Glycosides |
Thiazide and Thiazide-Like Diuretics may enhance the adverse/toxic effect of Cardiac Glycosides. Specifically, cardiac glycoside toxicity may be enhanced by the hypokalemic and hypomagnesemic effect of thiazide diuretics. |
|
Corticosteroids (Orally Inhaled) |
May enhance the hypokalemic effect of Thiazide and ThiazideLike Diuretics. |
|
Corticosteroids (Systemic) |
May enhance the hypokalemic effect of Thiazide and Thiazide-Like Diuretics. |
|
Cyclophosphamide |
Thiazide and Thiazide-Like Diuretics may enhance the adverse/toxic effect of Cyclophosphamide. Specifically, granulocytopenia may be enhanced. |
|
Dapoxetine |
May enhance the orthostatic hypotensive effect of Angiotensin-Converting Enzyme Inhibitors. |
|
Dexketoprofen |
May enhance the adverse/toxic effect of Sulfonamides. |
|
Dexmethylphenidate |
May diminish the therapeutic effect of Antihypertensive Agents. |
|
Diacerein |
May enhance the therapeutic effect of Diuretics. Specifically, the risk for dehydration or hypokalemia may be increased. |
|
Diazoxide |
Thiazide and Thiazide-Like Diuretics may enhance the adverse/toxic effect of Diazoxide. |
|
Diazoxide |
May enhance the hypotensive effect of Blood Pressure Lowering Agents. |
|
Dichlorphenamide |
Thiazide and Thiazide-Like Diuretics may enhance the hypokalemic effect of Dichlorphenamide. |
|
Dipeptidyl Peptidase-IV Inhibitors |
May enhance the adverse/toxic effect of AngiotensinConverting Enzyme Inhibitors. Specifically, the risk of angioedema may be increased. |
|
Drospirenone |
Angiotensin-Converting Enzyme Inhibitors may enhance the hyperkalemic effect of Drospirenone. |
|
DULoxetine |
Blood Pressure Lowering Agents may enhance the hypotensive effect of DULoxetine. |
|
Eplerenone |
May enhance the hyperkalemic effect of Angiotensin-Converting Enzyme Inhibitors. |
|
Everolimus |
May enhance the adverse/toxic effect of Angiotensin-Converting Enzyme Inhibitors. Specifically, the risk of angioedema may be increased. |
|
Ferric Gluconate |
Angiotensin-Converting Enzyme Inhibitors may enhance the adverse/toxic effect of Ferric Gluconate. |
|
Ferric Hydroxide Polymaltose Complex |
Angiotensin-Converting Enzyme Inhibitors may enhance the adverse/toxic effect of Ferric Hydroxide Polymaltose Complex. Specifically, the risk for angioedema or allergic reactions may be increased. |
|
Gelatin (Succinylated) |
Angiotensin-Converting Enzyme Inhibitors may enhance the adverse/toxic effect of Gelatin (Succinylated). Specifically, the risk of a paradoxical hypotensive reaction may be increased. |
|
Gold Sodium Thiomalate |
Angiotensin-Converting Enzyme Inhibitors may enhance the adverse/toxic effect of Gold Sodium Thiomalate. An increased risk of nitritoid reactions has been appreciated. |
|
Heparin |
May enhance the hyperkalemic effect of Angiotensin-Converting Enzyme Inhibitors. |
|
Heparins (Low Molecular Weight) |
May enhance the hyperkalemic effect of AngiotensinConverting Enzyme Inhibitors. |
|
Herbs (Hypertensive Properties) |
May diminish the antihypertensive effect of Antihypertensive Agents. |
|
Herbs (Hypotensive Properties) |
May enhance the hypotensive effect of Blood Pressure Lowering Agents. |
|
Hypotension-Associated Agents |
Blood Pressure Lowering Agents may enhance the hypotensive effect of Hypotension-Associated Agents. |
|
Icatibant |
May diminish the antihypertensive effect of Angiotensin-Converting Enzyme Inhibitors. |
|
Ipragliflozin |
May enhance the adverse/toxic effect of Thiazide and Thiazide-Like Diuretics. Specifically, the risk for intravascular volume depletion may be increased. |
|
Ivabradine |
Thiazide and Thiazide-Like Diuretics may enhance the arrhythmogenic effect of Ivabradine. |
|
Levodopa-Containing Products |
Blood Pressure Lowering Agents may enhance the hypotensive effect of Levodopa-Containing Products. |
|
Licorice |
May enhance the hypokalemic effect of Thiazide and Thiazide-Like Diuretics. |
|
Loop Diuretics |
May enhance the hypotensive effect of Angiotensin-Converting Enzyme Inhibitors. Loop Diuretics may enhance the nephrotoxic effect of Angiotensin-Converting Enzyme Inhibitors. |
|
Lormetazepam |
May enhance the hypotensive effect of Blood Pressure Lowering Agents. |
|
Methenamine |
Thiazide and Thiazide-Like Diuretics may diminish the therapeutic effect of Methenamine. |
|
Methylphenidate |
May diminish the antihypertensive effect of Antihypertensive Agents. |
|
Molsidomine |
May enhance the hypotensive effect of Blood Pressure Lowering Agents. |
|
Multivitamins/Fluoride (with ADE) |
May enhance the hypercalcemic effect of Thiazide and Thiazide-Like Diuretics. |
|
Multivitamins/Minerals (with ADEK, Folate, Iron) |
Thiazide and Thiazide-Like Diuretics may enhance the hypercalcemic effect of Multivitamins/Minerals (with ADEK, Folate, Iron). |
|
Multivitamins/Minerals (with AE, No Iron) |
Thiazide and Thiazide-Like Diuretics may increase the serum concentration of Multivitamins/Minerals (with AE, No Iron). Specifically, thiazide diuretics may decrease the excretion of calcium, and continued concomitant use can also result in metabolic alkalosis. |
|
Naftopidil |
May enhance the hypotensive effect of Blood Pressure Lowering Agents. |
|
Neuromuscular-Blocking Agents (Nondepolarizing) |
Thiazide and Thiazide-Like Diuretics may enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents (Nondepolarizing). |
|
Nicergoline |
May enhance the hypotensive effect of Blood Pressure Lowering Agents. |
|
Nicorandil |
May enhance the hyperkalemic effect of Angiotensin-Converting Enzyme Inhibitors. |
|
Nicorandil |
May enhance the hypotensive effect of Blood Pressure Lowering Agents. |
|
Nitroprusside |
Blood Pressure Lowering Agents may enhance the hypotensive effect of Nitroprusside. |
|
Nonsteroidal Anti-Inflammatory Agents |
Angiotensin-Converting Enzyme Inhibitors may enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents. Specifically, the combination may result in a significant decrease in renal function. Nonsteroidal Anti-Inflammatory Agents may diminish the antihypertensive effect of Angiotensin-Converting Enzyme Inhibitors. |
|
Nonsteroidal Anti-Inflammatory Agents |
Thiazide and Thiazide-Like Diuretics may enhance the nephrotoxic effect of Nonsteroidal Anti-Inflammatory Agents. Nonsteroidal Anti-Inflammatory Agents may diminish the therapeutic effect of Thiazide and Thiazide-Like Diuretics. |
|
Opioid Agonists |
May enhance the adverse/toxic effect of Diuretics. Opioid Agonists may diminish the therapeutic effect of Diuretics. |
|
Oxcarbazepine |
Thiazide and Thiazide-Like Diuretics may enhance the adverse/toxic effect of OXcarbazepine. Specifically, there may be an increased risk for hyponatremia. |
|
Pentoxifylline |
May enhance the hypotensive effect of Blood Pressure Lowering Agents. |
|
Pholcodine |
Blood Pressure Lowering Agents may enhance the hypotensive effect of Pholcodine. |
|
Phosphodiesterase 5 Inhibitors |
May enhance the hypotensive effect of Blood Pressure Lowering Agents. |
|
Porfimer |
Photosensitizing Agents may enhance the photosensitizing effect of Porfimer. |
|
Potassium Salts |
May enhance the hyperkalemic effect of Angiotensin-Converting Enzyme Inhibitors. |
|
Potassium-Sparing Diuretics |
May enhance the hyperkalemic effect of Angiotensin-Converting Enzyme Inhibitors. |
|
Pregabalin |
Angiotensin-Converting Enzyme Inhibitors may enhance the adverse/toxic effect of Pregabalin. Specifically, the risk of angioedema may be increased. |
|
Prostacyclin Analogues |
May enhance the hypotensive effect of Blood Pressure Lowering Agents. |
|
Quinagolide |
May enhance the hypotensive effect of Blood Pressure Lowering Agents. |
|
Racecadotril |
May enhance the adverse/toxic effect of Angiotensin-Converting Enzyme Inhibitors. Specifically, the risk for angioedema may be increased with this combination. |
|
Ranolazine |
May enhance the adverse/toxic effect of Angiotensin-Converting Enzyme Inhibitors. |
|
Reboxetine |
May enhance the hypokalemic effect of Thiazide and Thiazide-Like Diuretics. |
|
Salicylates |
May enhance the nephrotoxic effect of Angiotensin-Converting Enzyme Inhibitors. Salicylates may diminish the therapeutic effect of Angiotensin-Converting Enzyme Inhibitors. |
|
Selective Serotonin Reuptake Inhibitors |
May enhance the hyponatremic effect of Thiazide and Thiazide-Like Diuretics. |
|
Sirolimus |
May enhance the adverse/toxic effect of Angiotensin-Converting Enzyme Inhibitors. |
|
Tacrolimus (Systemic) |
Angiotensin-Converting Enzyme Inhibitors may enhance the hyperkalemic effect of Tacrolimus (Systemic). |
|
Temsirolimus |
May enhance the adverse/toxic effect of Angiotensin-Converting Enzyme Inhibitors. |
|
Thiazide and Thiazide-Like Diuretics |
May enhance the hypotensive effect of AngiotensinConverting Enzyme Inhibitors. Thiazide and Thiazide-Like Diuretics may enhance the nephrotoxic effect of Angiotensin-Converting Enzyme Inhibitors. |
|
TiZANidine |
May enhance the hypotensive effect of Angiotensin-Converting Enzyme Inhibitors. |
|
Tolvaptan |
May enhance the hyperkalemic effect of Angiotensin-Converting Enzyme Inhibitors. |
|
Toremifene |
Thiazide and Thiazide-Like Diuretics may enhance the hypercalcemic effect of Toremifene. |
|
Trimethoprim |
May enhance the hyperkalemic effect of Angiotensin-Converting Enzyme Inhibitors. |
|
Verteporfin |
Photosensitizing Agents may enhance the photosensitizing effect of Verteporfin. |
|
Vitamin D Analogs |
Thiazide and Thiazide-Like Diuretics may enhance the hypercalcemic effect of Vitamin D Analogs. |
|
Yohimbine |
May diminish the antihypertensive effect of Antihypertensive Agents. |
|
Risk Factor D (Consider therapy modification) |
|
|
Aliskiren |
May enhance the hyperkalemic effect of Angiotensin-Converting Enzyme Inhibitors. Aliskiren may enhance the hypotensive effect of Angiotensin-Converting Enzyme Inhibitors. Aliskiren may enhance the nephrotoxic effect of Angiotensin-Converting Enzyme Inhibitors. Management: Aliskiren use with ACEIs or ARBs in patients with diabetes is contraindicated. Combined use in other patients should be avoided, particularly when CrCl is less than 60 mL/min. If combined, monitor potassium, creatinine, and blood pressure closely. |
|
Allopurinol |
Angiotensin-Converting Enzyme Inhibitors may enhance the potential for allergic or hypersensitivity reactions to Allopurinol. |
|
Amifostine |
Blood Pressure Lowering Agents may enhance the hypotensive effect of Amifostine. Management: When amifostine is used at chemotherapy doses, blood pressure lowering medications should be withheld for 24 hours prior to amifostine administration. If blood pressure lowering therapy cannot be withheld, amifostine should not be administered. |
|
Angiotensin II Receptor Blockers |
|
|
Bile Acid Sequestrants |
May decrease the absorption of Thiazide and Thiazide-Like Diuretics. The diuretic response is likewise decreased. |
|
Grass Pollen Allergen Extract (5 Grass Extract) |
Angiotensin-Converting Enzyme Inhibitors may enhance the adverse/toxic effect of Grass Pollen Allergen Extract (5 Grass Extract). Specifically, ACE inhibitors may increase the risk of severe allergic reaction to Grass Pollen Allergen Extract (5 Grass Extract). |
|
Iron Dextran Complex |
Angiotensin-Converting Enzyme Inhibitors may enhance the adverse/toxic effect of Iron Dextran Complex. Specifically, patients receiving an ACE inhibitor may be at an increased risk for anaphylactic-type reactions. Management: Follow iron dextran recommendations closely regarding both having resuscitation equipment and trained personnel on-hand prior to iron dextran administration and the use of a test dose prior to the first therapeutic dose. |
|
Lanthanum |
May decrease the serum concentration of Angiotensin-Converting Enzyme Inhibitors. Management: Administer angiotensin-converting enzyme inhibitors at least two hours before or after lanthanum. |
|
Lithium |
Thiazide and Thiazide-Like Diuretics may decrease the excretion of Lithium. |
|
Lithium |
Angiotensin-Converting Enzyme Inhibitors may increase the serum concentration of Lithium. Management: Lithium dosage reductions will likely be needed following the addition of an ACE inhibitor. Monitor patient response to lithium closely following addition or discontinuation of concurrent ACE inhibitor treatment. |
|
Obinutuzumab |
May enhance the hypotensive effect of Blood Pressure Lowering Agents. Management: Consider temporarily withholding blood pressure lowering medications beginning 12 hours prior to obinutuzumab infusion and continuing until 1 hour after the end of the infusion. |
|
Sodium Phosphates |
Angiotensin-Converting Enzyme Inhibitors may enhance the nephrotoxic effect of Sodium Phosphates. Specifically, the risk of acute phosphate nephropathy may be enhanced. Management: Consider avoiding this combination by temporarily suspending treatment with ACEIs, or seeking alternatives to oral sodium phosphate bowel preparation. If the combination cannot be avoided, maintain adequate hydration and monitor renal function closely. |
|
Sodium Phosphates |
Diuretics may enhance the nephrotoxic effect of Sodium Phosphates. Specifically, the risk of acute phosphate nephropathy may be enhanced. Management: Consider avoiding this combination by temporarily suspending treatment with diuretics, or seeking alternatives to oral sodium phosphate bowel preparation. If the combination cannot be avoided, hydrate adequately and monitor fluid and renal status. |
|
Topiramate |
Thiazide and Thiazide-Like Diuretics may enhance the hypokalemic effect of Topiramate. Thiazide and Thiazide-Like Diuretics may increase the serum concentration of Topiramate. Management: Monitor for increased topiramate levels/adverse effects (e.g., hypokalemia) with initiation/dose increase of a thiazide diuretic. Closely monitor serum potassium concentrations with concomitant therapy. Topiramate dose reductions may be necessary. |
|
Urapidil |
May interact via an unknown mechanism with Angiotensin-Converting Enzyme Inhibitors. Management: Avoid concomitant use of urapidil and angiotensin-converting enzyme (ACE) inhibitors. |
|
Risk Factor X (Avoid combination) |
|
|
Aminolevulinic Acid (Systemic) |
Photosensitizing Agents may enhance the photosensitizing effect of Aminolevulinic Acid (Systemic). |
|
Bromperidol |
Blood Pressure Lowering Agents may enhance the hypotensive effect of Bromperidol. Bromperidol may diminish the hypotensive effect of Blood Pressure Lowering Agents. |
|
Dofetilide |
HydroCHLOROthiazide may enhance the QTc-prolonging effect of Dofetilide. HydroCHLOROthiazide may increase the serum concentration of Dofetilide. |
|
Fexinidazole [INT] |
Thiazide and Thiazide-Like Diuretics may enhance the arrhythmogenic effect of Fexinidazole [INT]. |
|
Levosulpiride |
Thiazide and Thiazide-Like Diuretics may enhance the adverse/toxic effect of Levosulpiride. |
|
Mecamylamine |
Sulfonamides may enhance the adverse/toxic effect of Mecamylamine. |
|
Promazine |
Thiazide and Thiazide-Like Diuretics may enhance the QTc-prolonging effect of Promazine. |
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Sacubitril |
Angiotensin-Converting Enzyme Inhibitors may enhance the adverse/toxic effect of Sacubitril. Specifically, the risk of angioedema may be increased with this combination. |
Monitoring parameters:
Regular monitoring of blood pressure, BUN, serum creatinine, and electrolytes are necessary. Do CBC with differentials, more frequently if the patient has collagen vascular disease and/or renal impairment. [/bg_collapse] [bg_collapse view="button-blue" color="#f7f2f2" icon="arrow" expand_text="How to administer?" collapse_text="How to administer?" ]
How to administer Moexipril and hydrochlorothiazide (Uniretic)?
Oral: Administer one hour before a meal. [/bg_collapse] [bg_collapse view="button-blue" color="#f7f2f2" icon="arrow" expand_text="Pharmacology & MOA" collapse_text="Pharmacology & MOA" ]
Mechanism of action of Moexipril and hydrochlorothiazide (Uniretic):
Moexipril
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- It is a competitive inhibitor of angiotensin-converting enzyme (ACE). It inhibits angiotensin-converting enzyme (ACE) conversion to angiotensin II. This is a powerful vasoconstrictor. It causes angiotensin II levels to drop, which results in increased plasma renin activity as well as a decrease in aldosterone production.
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Hydrochlorothiazide:
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- It inhibits sodium reabsorption from the distal tubules, causing an increase in excretion of sodium, water, as well as potassium ions and hydrogen ions.
See individual agents. [/bg_collapse] [bg_collapse view="button-blue" color="#f7f2f2" icon="arrow" expand_text="International Brands" collapse_text="International Brands" ]
International Brand Names of Moexipril and hydrochlorothiazide:
- Fempress Plus
- Moex Plus
- Uniretic
- Univasc Plus
[/bg_collapse] [bg_collapse view="button-blue" color="#f7f2f2" icon="arrow" expand_text="Brands in Pakistan" collapse_text="Brands in Pakistan" ]
Moexipril and hydrochlorothiazide Brand Names in Pakistan:
No Brands Available in Pakistan. [/bg_collapse]
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